The present invention relates to methods and devices for treatment of urinary pathologies.
Male incontinence is a condition characterized by involuntary loss of urine, beyond the individual""s control. One cause for this condition is damage to the urethral sphincter, such as can occur after prostatectomy, after radiation or after pelvic accidents. Other accepted reasons for male incontinence include bladder instability, over-flowing incontinence and fistulas.
The present application is directed to the treatment of male urinary incontinence which is related to urethral sphincter damage. Currently, the treatment of choice involves implantation of a Kaufman Prosthesis, an artificial sphincter (such as AMS-800), and a sling procedure in which a sling is inserted beneath the urethra and advanced in the retro pubic space, and perforating the abdominal fascia, such as in female sling procedures. See, Joseph J. Kaufman and Shlomo Raz, Urethral compression procedure for the treatment of male urinary incontinence, Journal of Urology 121: 605-608 (1979).
Cystocele is a condition in which, due to laxity of the pelvic floor, the bladder extrudes out and downwards. The severity of this bladder collapse is rated between grades 1-4. In grade four cystocele, the bladder extrudes out of the vaginal opening. The treatment of choice for this condition includes the reduction or closing of the pelvic floor opening from which the bladder descends using sutures.
As background to the inventions of the present application, further information is provided in the following publications, the disclosures of which are fully incorporated herein by reference: Eddie H. M. Sze, M. D and Mickey M. Karrara, M. D., Transvaginal repair of vault prolapse: a review, Obstetrics and Gynecology 89(3): 466-475 (1997); Shlomo Raz, M. D., Female Urology, Chapter 29 (Pathogenesis of Cystocele), Chapter 43 (Uterine Prolapse), Chapter 44 (Enterocele and Vault Prolapse); Joseph J. Kaufman and Shlomo Raz, Urethral compression procedure for the treatment of male urinary incontinence, Journal of Urology 121: 605-608 (1979); Robert Cox and Peter H. L. Worth, Results of Treatment of Post-Prostatectomy Incontinence Using the Kaufman Prosthesis, Eur. Urol. 12: 154-157 (1986); Olavi A. Lukkarinen, Matti J. Kontturi, et al., Treatment of Urinary Incontinence with an Implantable Prosthesis, Scan. J. Urol. Nephrol. 23: 85-88 (1989); Sender Herschorn and Sidney B. Radomski, Fascial Slings and Bladder Neck Tapering in the Treatment of Male Neurogenic Incontinence, J. Urology 147: 1073-1075 (1992); Gene R. Barrett, M. D. Stephen H. Treacy, M. D. and Cynthi a G. Ruff, M. S., Preliminary Results of the T-Fix Endoscopic Meniscus Repair Technique in an Anterior Cruciate Ligament Reconstruction Population, Arthroscopy: The Journal of Arthroscopic and Related Surgery, 13: 218-223 (1997).
In one embodiment, the present invention relates to apparatus and methods for treatment of male incontinence and a method for female cystocele repair in which a sling material is positioned between the descending rami of the pubic bone. In such an operation a xe2x80x9chammock-likexe2x80x9d sling material is positioned below the urethra in males, or below the posterior bladder wall in the case of cystocele in females.
In the male case, this sling applies passive compression against the bulbar urethra. The compression, either by itself or in conjunction with urethral mobility, prevents urine leak during strain. If additional passive pressure is required on the urethra after surgery is completed, collagen or other bulky material can be injected with a tiny needle through the perineum, causing more pressure created by the bulky material held on one side (the lower side) by the sling, and on the other side compressing the urethra.
In another embodiment of the invention, an especially flat shaped balloon is positioned between the sling material and the urethra to provide desired compression. Examples of inflatable balloon devices are disclosed in U.S. Patent entitled Systems for Percutaneous Bone and Spinal Stabilization, Fixation and Repair, (U.S. Pat. No. 6,127,597), filed Mar. 6, 1998 by Mordechay Beyar, Oren Globerman and Elad Magal, the disclosure of which is fully incorporated herein by reference. This balloon is inflated with fluid, and the volume can be adjusted by inflation or reduction of the fluid inside the balloon, using a tiny needle inserted through the perineal area. In a further embodiment of the invention, the sling material is part of the flat balloon. The sling material and the balloon can be either be an integral single unit, or the sling material can be attached or secured to the balloon. Inflation and deflation of the balloon, in conjunction with the sling (which is preferably secured using suitable bone anchors and suture), is used to correct the urinary pathology, in accordance with the methods disclosed herein. The sling is attached to the bone by means of bone anchors.
In another embodiment of the invention, T-anchors and anchor inserters are provided herein. The anchors and inserters are designed for use with gynecological and urological procedures, including, but not limited to, bladder neck suspension, sacrospinous ligament procedures for the treatment of vaginal vault prolapse, and sling procedures for the treatment of urinary stress incontinence and cystocele repair.
Further disclosure of the surgical procedures in the sling procedure are provided below.